Chronic back, leg, or arm pain (failed back syndrome or postlaminectomy syndrome)

Sciatica

Reduction of mobility from pain

Pain and discomfort derived from consistent nerve irritation

Stiffened muscles

Spasms

Spine benign/malignant trauma

Spine benign/malignant disorder

Vascular benign/malignant lesion

Patient history

Physical examination

Neurologic examination

MRI of spine

CT of spine

X-ray of spine

PET of spine

Muscle spasticity

Cord compression

Arachnoiditis

Multiple sclerosis

Spinal cord injury

Failed back surgery syndrome

Complex regional pain syndrome

Stump pain

Angina

Peripheral vascular disease

Stroke

Acute pain control with medications and pain management

Physical therapy and rehabilitation

If asymptomatic or mildly symptomatic with cord compression:

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  Surgical decompression and fusion of implicated segments if deemed suitable candidate for surgery

  
  
  
  
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    If poor surgical candidate with poor life expectancy, medical management recommended

If asymptomatic without cord compression and no relief from other therapies:

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  Baclofen pump (permanent pump implant that delivers baclofen to spinal fluid, treating spasticity refractory to oral medications and chronic pain associated with moderate to severe spasticity) (see ▶Fig. 18.1)

  

  
  
  
  
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    Baclofen is a GABA_B Receptor agonist, promoting muscle relaxation

    
    
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    Morphine may be used instead of baclofen

  
  
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  Spinal cord stimulation (masks nociception before it reaches the brain, resulting in non perception of pain)

  
  
  
  
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    Pain relief varies from person to person

    
    
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    Includes: (1) pulse generator with battery, (2) lead wire with 8 to 32 electrodes, and (3) remote control to adjust settings and turn the device on or off

    
    
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    Must perform a trial placement showing over 50% pain relief with psychological clearance and no untreated drug addiction or habituation